Apply Online

Please fill in all areas of the application. Include all family members in the household. Income documents, immunization records and birth records can be sent to alewis@thrivalaska.com. You are welcome to bring the documents in for us to copy or fax to 907-452-4203 If you have any questions don't hesitate to contact us and ask for enrollment specialist 907-452-4267

First Name (Required)

Middle Name

Last Name (Required)

Birthday (Required)

Gender

Email Address (Required)

Confirm Email Address

It appears that you have previously submitted an application. If you wish to apply again, please contact us by phone or in person.

Mobile Phone

Opt In for Text Messages

Home Phone

Work Phone

Ext.

It appears that you have previously submitted an application. If you wish to apply again, please contact us by phone or in person.

Race

Hispanic

English Proficiency

Other Language

Other Language Proficiency

Highest Grade Completed

Employment Status

Child's Relationship

Custody

Lives with Family

Provides Financial Support

Teen Parent

Is your family experiencing homelessness?

Living Address (Required)

Address Line 2

City (Required)

State (Required)

ZIP (Required)

Click here to find a provider in your area.

Mailing Address same as Living Address

Mailing Address

Address Line 2

City

State

ZIP

Is there another parent/guardian in the family?

First Name (Required)

Middle Name

Last Name (Required)

Birthday (Required)

Gender

Email Address

Confirm Email Address

It appears that you have previously submitted an application. If you wish to apply again, please contact us by phone or in person.

Mobile Phone

Opt In for Text Messages

Home Phone

Work Phone

Ext.

It appears that you have previously submitted an application. If you wish to apply again, please contact us by phone or in person.

Race

Hispanic

English Proficiency

Other Language

Other Language Proficiency

Highest Grade Completed

Employment Status

Child's Relationship

Custody

Lives with Family

Provides Financial Support

Teen Parent

Are there other adults in the household?

Add Another Adult

INCOME DOCUMENTS. We are required to verify household income for the past 12 months. You will be asked to provide documents to determine your income eligibility. Such documents are: Pay stub showing year-to-date earned, LES showing your Base Pay, Award Letters from universities for grants or scholarships, Cash Assistance letter with amount received for each month and the number of months you are eligible, PFD for all family members, Other Dividends from native corporations, Letter from Supplemental Security Income showing eligibility. If your family situation has changed recently, you may explain how income will be calculated. Special circumstances apply to deployed parent, families with no income, homeless families, and children in foster care. Documents may be delivered to Head Start or email to headstartenrollment@gmail.com or fax 907-452-4203

Number of Parents/Guardians

Relationship to Participant(s)

Primary Language at Home

Is another language being acquired or learned at home?

Number in Household

Number in Family

Gross Annual Income

Is your family receiving cash benefits or other services under the Temporary Assistance for Needy Families (TANF) program?

Is your family receiving Supplemental Security Income (SSI)?

Is your family receiving services from WIC?

Is your family receiving services under the Supplemental Nutrition Assistance Program (SNAP), formerly referred to as Food Stamps?

Is at least one parent/guardian an active duty member of the United States military?

Is at least one parent/guardian a veteran of the United States military?

Please note here which class you would prefer. Morning 7:45 to 11:45_________ or Afternoon 12:14-4:15 ______________ You will be asked to provide a current immunization record and a birth certificate or insurance card with date of birth for your child. You may bring the documents to Head Start or email to headstartenrollment@gmail.com or fax to 907-452-4203

First Name (Required)

Middle Name

Last Name (Required)

Suffix

Nickname

Birthday (Required)

Gender

Race

Hispanic

English Proficiency

Other Language

Other Language Proficiency

Primary Health Coverage

Other Coverage

Medicaid Eligibility

Doctor/Medical Home

Dental Coverage

Dentist/Dental Home

Does your child have a disability or do you have any concerns about your child's development?

Is there anything else you want to tell us about your child?

Which program are you applying for? (Required)

Location Preference

1st Location Preference

2nd Location Preference

3rd Location Preference

- Your Address - Available Locations

Click a location on the map to see more info

Click here to find a provider in your area.

Do you want to apply now for another child in your family?

Add Another Applicant

Are there other children in the family?

Add a Sibling

Income documents, immunization records and birth records can be sent to alewis@thrivalaska.com. You are welcome to bring the documents in for us to copy or fax to 907-452-4203. We enroll children all year as space is available. Please notify us if your contact information changes. Thank you for your interest in our Birth to Five Head Start Program! The enrollment specialist will be in contact with you for the next steps of the process.

Required information is missing, see above.

Parent/Guardian

Address

Additional Parent/Guardian

Other Adults

Family Information

Child (Applicant)

Location Preferences

Additional Applicant

Siblings